Healthcare Provider Details

I. General information

NPI: 1487721841
Provider Name (Legal Business Name): DEX WHITEHEAD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUNDANCE BEHAVIORAL RESOURCES 845 EAST 4800 SOUTH, SUITE 200
MURRAY UT
84107-5041
US

IV. Provider business mailing address

SUNDANCE BEHAVIORAL RESOURCES 845 EAST 4800 SOUTH, SUITE 200
MURRAY UT
84107-5041
US

V. Phone/Fax

Practice location:
  • Phone: 801-264-9522
  • Fax: 801-265-9604
Mailing address:
  • Phone: 801-264-9522
  • Fax: 801-265-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137284-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: